Vanessa L. Pickett, Ed.S., LPCA
PROFESSIONAL DISCLOSURE STATEMENT
This information is intended to inform you about my background, business policies, and to describe certain issues regarding our therapeutic relationship. Please read it carefully and feel free to ask any questions you may have. Under HIPAA and the American Counseling Association (ACA) Code of Ethics, I am legally and ethically responsible to provide you with informed consent. When you sign this document, it will represent an agreement between us.
EDUCATION AND LICENSURE
I have received a Specialist’s Degree (Ed.S.) in Psychology and Counselingfrom Arkansas State University in 2009 and a Bachelor’s Degree (B.A.) in Psychology from Lyon College in 2004. I have been a professional counselor since 2009. I have successfully met the professional counseling standards established by the North Carolina Board of Licensed Professional Counselors. I am licensed as a Licensed Professional Counselor Associate (LPCA), License Number A11983.
COUNSELING SERVICES OFFERED
In my counseling practice, I provide individual, group, and relationship counseling serving children, adolescents, and adults. Counseling is not easily described in general statements. It varies depending on the personalities of the counselor and the client and the particular problems that you bring forward. There are many different methods I may use to deal with the problems that you hope to address. Counseling is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the counseling to be most successful, you will have to work on things we talk about both during our sessions and outside of our sessions.
I utilize the Diagnostic and Statistical Manual of the American Psychiatric Association, Fifth Edition (DSM-V) to make clinical diagnoses. I work with a variety of disorders including but not limited to mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders, eating disorders, adjustment disorders, personality disorders, and disorders first diagnosed in childhood such as oppositional defiant disorder, disruptive behavior disorder, autism spectrum disorders, and ADHD. Furthermore, I also work with individuals and families dealing with common life experiences such as death, grief, academic issues, occupational issues, relationship issues, parenting problems, and social interaction difficulties. When you enter into a counseling relationship, your diagnosis as outlined in the DSM-V will become a part of your permanent counseling record.
Counseling can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, counseling has also been shown to have benefits for people who engage in it. Counseling often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress but there are no guarantees of what you will experience.
METHODS AND TECHNIQUES
I use a wide variety of methods and techniques when working with clients. Every client is different, however, so my approach varies from client to client. The techniques I use are always intended to assist the client to understand or express self more fully, gain insight, make desired changes, and assess current behaviors and “quality world.” I consistently use empathy and active listening skills when working with clients as well as common Reality Therapy techniques such as evaluation of present behavior, exploration of willingness to change, development of specific plan to change, exploration of awareness of how life would be different, and commitment to follow through with plan. I borrow techniques from Adlerian theory in working with families such as genograms and family constellations and homework assignments. In working with children and adolescents, I use innovative techniques including games, art activities, bibliotherapy, play, simulation activities, storytelling, role-playing, music, puppets, and journaling. I also use cognitive-behavioral techniques in working with individuals of all ages.
CONFIDENTIALITY
All of our communication becomes part of your clinical record, which is accessible to you upon request. In general, the privacy of all communication between a client and a counselor is protected by law. I can only release information about your counseling experience to third parties with your prior, written consent for release of that information. But there are a few exceptions.
In accordance with my professional code of ethics with the American Counseling Association, there are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child, elderly person, or disabled person is being abused and/or neglected, I am required to file a report with the appropriate state agency.
If I believe that a client is threatening serious bodily harm to another or to one’s self, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, and/or seeking hospitalization for the patient. If the client threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.
In rare circumstances, counselors can be ordered by a judge to release counseling information during court proceedings.
These situations have rarely occurred in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action. If you request, I will provide you with relevant portions or summaries of the state laws and/or the American Counseling Association code of ethics regarding these issues.
MINORS
One risk during child/adolescent therapy involves disagreement among parents/guardians and/or disagreement between parents/guardians and counselor regarding the best interests of the minor child. If such disagreements occur, I will strive to listen carefully so that I can understand your perspectives and fully explain my perspective. We can resolve such disagreements or we can agree to disagree, so long as this enables your child’s therapeutic progress. Ultimately, you will decide whether therapy will continue. If you decide that therapy should end, I will honor that decision, however I ask that you allow me the option of having a few closing sessions to appropriately end the treatment relationship.
If you are under eighteen years of age and engaged in counseling with me, please be aware that the law provides your guardian(s) the rights to your treatment records. It is my policy to request an agreement from your guardian(s) that they agree not to seek these records. If they agree, I will provide them only with general information about our work together, unless I feel there is a high risk that you will seriously harm yourself or someone else or in cases in which you may be engaging in risky and/or potential dangerous behaviors. In this case, I will notify your guardian(s) of my concern. Before giving them any information, I will discuss the matter with you, if possible, and do my best to handle any objections you may have with what I am prepared to discuss. At the end of your treatment, I will prepare a summary of our work together for your guardian(s) and we will discuss it beforehand.
Being involved in custody controversies, custody evaluations, or family court is not a function of my counseling. My philosophy is to be child-focused and to assist children in adjusting to decisions that are made by the court or mediation. I am trained to listen to and counsel children, but I am not trained to evaluate the family situation nor to make recommendations to the court. In fact, the focus of my counseling with the child makes to attempt to identify or explore the issues that would be relevant to court proceedings. If you have an attorney, please communicate to him or her that I am not trained to evaluate the family situation and make recommendations regarding the same to the court. If your attorney feels as though testimony of your child’s counselor is vital to your custody actions, you should retain a counselor from the beginning who regularly testifies in custody actions.
SESSIONS
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and treatment goals will be identified. Our time together will involve working toward your specified treatment goals to improve your functioning across multiple life settings and to also enhance your relationships and interactions with others. Upon completion of those identified goals, treatment will terminate unless additional goals are identified.
I typically schedule one, 50 minute, individual session per week at a time that we agree on, although some sessions may be longer or more frequent. When working with child and adolescent clients, I also encourage the family to participate in family therapy at least one time per month to explore family dynamics as related to identified treatment goals for the child/adolescent. If deemed appropriate, you may also participate in group therapy with peers as related to treatment goals.
AFTER HOURS CRISIS LINE
In the event that you experience a mental health emergency/crisis occurring after Black Mountain Counseling Center’s scheduled business hours, you may reach our counselor on call by dialing (828) 333-1001. You may also call 911 or go immediately to your nearest hospital emergency room.
FEES AND METHODS OF PAYMENT
The Black Mountain Counseling Center is a non-profit center and offers a sliding scale. I am also an in-network provider for Medicaid and BlueCross BlueShield Insurance. If insurance is used, a diagnosis must be made and will become part of the client’s permanent medical record.
Fees are due at the time the service is rendered. Cash, credit/debit card, or personal checks are appropriate methods of payment and Black Mountain Counseling Center will provide a receipt for all fees paid. Clients are seen by appointment only.
If you are unable to keep an appointment, please call the office to cancel or reschedule at least 24 hours in advance. If I do not receive such advance notice, you will be responsible for paying for the session(s) that you missed. If you are late for an appointment, I will be happy to see you for the remaining time available, but you will be expected to pay for the full appointment time.
COMPLAINT PROCEDURE
You should carefully evaluate all information presented in this personal disclosure statement to determine whether you feel comfortable working with me. Therapy involves a large commitment of time and energy. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion and/or provide a referral. Should a concern arise regarding my practices, I ask that you first discuss it with me so that I may make every effort to appropriately resolve the issue if possible. However, should you feel that you must act further or think that I have treated you unfairly or unethically and we cannot resolve the problem, you may contact:
North Carolina Board of Licensed Professional Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: (844) 622-3572
Fax: (336) 217-9450
Email:
CONSENT TO TREATMENT
Your signature below indicates 1) that you voluntarily agree to receive counseling assessment and counseling services and that you authorize me to provide such counseling assessment, treatment, or services; 2) that you have read and understand the information described in this “Professional Disclosure Statement”; 3) that you have had the opportunity to ask questions and seek clarification of anything unclear to you.
This disclosure statement is intended to provide you with the information needed for your informed consent to begin counseling services. You always have the right to consent to treatment, and likewise, you have the right to withdraw that consent at any time. By signing below you are acknowledging that you have read and understand this document and agree with the conditions outlined. This agreement will remain in effect for the duration of services.
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Client Name (Print) Client Signature Date
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Parent/Guardian Name (if minor) Parent/Guardian Signature Date
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Counselor Name (Print) Counselor Signature Date
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Vanessa L. Pickett, Ed.S., LPCA Professional Disclosure Statement